|
Tx closed hip disl traumatic without anes
|
$172.80 |
$172.80 |
$172.80 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,878.00 |
$4,878.00 |
$4,878.00 |
$3,977.49
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$16,360.83 |
$16,360.83 |
$16,360.83 |
$4,468.55
|
|
Tx open nsl fx uncomp
|
$13,221.00 |
$13,221.00 |
$13,221.00 |
$3,837.72
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$13,923.74 |
$13,923.74 |
$13,923.74 |
$4,499.12
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$394.20
|
|
Ultrasound breast complete
|
$600.00 |
$600.00 |
$600.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$583.20 |
$583.20 |
$583.20 |
$449.35
|
|
Ultrasound chest
|
$1,002.00 |
$1,002.00 |
$1,002.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$523.80 |
$523.80 |
$523.80 |
$338.00
|
|
Ultrasound encephalogram
|
$1,581.60 |
$1,581.60 |
$1,581.60 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,134.00 |
$1,134.00 |
$1,134.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$701.40 |
$701.40 |
$701.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,174.80 |
$1,174.80 |
$1,174.80 |
$720.15
|
|
Ultrasound guide tissue ablation
|
$500.40 |
$500.40 |
$500.40 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$700.20 |
$700.20 |
$700.20 |
$403.88
|
|
Ultrasound joint complete left
|
$696.00 |
$696.00 |
$696.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$615.60 |
$615.60 |
$615.60 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$829.80 |
$829.80 |
$829.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$530.40 |
$530.40 |
$530.40 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$3,756.00 |
$3,756.00 |
$3,756.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$677.40 |
$677.40 |
$677.40 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$829.80 |
$829.80 |
$829.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,838.40 |
$1,838.40 |
$1,838.40 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$855.60 |
$855.60 |
$855.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,823.40 |
$1,823.40 |
$1,823.40 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$964.20 |
$964.20 |
$964.20 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$991.80 |
$991.80 |
$991.80 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$3,078.00 |
$3,078.00 |
$3,078.00 |
$206.64
|
|
Umbilicoplasty 15847
|
$41,630.21 |
$41,630.21 |
$41,630.21 |
$4,172.97
|
|
Unlisted hystsc px uterus
|
$14,406.38 |
$14,406.38 |
$14,406.38 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$12,495.52 |
$12,495.52 |
$12,495.52 |
$5,419.00
|
|
Unlisted maaa
|
$141.60 |
$141.60 |
$141.60 |
$235.20
|
|
Unlisted mr procedure
|
$779.40 |
$779.40 |
$779.40 |
$1,163.00
|
|
Unlisted px hands/fingers
|
$453.60 |
$453.60 |
$453.60 |
$354.20
|
|
Unlisted px leg/ankle
|
$57,105.52 |
$57,105.52 |
$57,105.52 |
$811.00
|
|
Unlisted px tongue flr mouth
|
$174.00 |
$174.00 |
$174.00 |
$282.50
|
|
Unlisted px vestibule mouth
|
$461.40 |
$461.40 |
$461.40 |
$456.96
|
|
Unlstd laps px sprmatic cord
|
$16,288.61 |
$16,288.61 |
$16,288.61 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,419.60 |
$1,419.60 |
$1,419.60 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,525.00 |
$3,525.00 |
$3,525.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,852.20 |
$1,852.20 |
$1,852.20 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,289.60 |
$2,289.60 |
$2,289.60 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,662.18 |
$3,662.18 |
$3,662.18 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$5,214.09 |
$5,214.09 |
$5,214.09 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$6,437.46 |
$6,437.46 |
$6,437.46 |
$1,872.00
|
|
Urea nitrogen
|
$28.80 |
$28.80 |
$28.80 |
$41.46
|
|
Uric acid blood
|
$41.40 |
$41.40 |
$41.40 |
$48.75
|
|
Uric acid urine
|
$43.20 |
$43.20 |
$43.20 |
$44.33
|
|
Urinalysis microscopic only
|
$12.60 |
$12.60 |
$12.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$163.20 |
$163.20 |
$163.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$34.20 |
$34.20 |
$34.20 |
$35.75
|
|
Urine Culture Test
|
$156.00 |
$156.00 |
$156.00 |
$81.50
|
|
Urine pregnancy test
|
$124.80 |
$124.80 |
$124.80 |
$67.20
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$23,146.58 |
$23,146.58 |
$23,146.58 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$79,583.54 |
$79,583.54 |
$79,583.54 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$128.72 |
$128.72 |
$128.72 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$450.75 |
$450.75 |
$450.75 |
$164.63
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$29.40 |
$29.40 |
$29.40 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$24.60 |
$24.60 |
$24.60 |
$43.12
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$576.08 |
$576.08 |
$576.08 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$47.40 |
$47.40 |
$47.40 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$97.20 |
$97.20 |
$97.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$114.56 |
$114.56 |
$114.56 |
$75.39
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$25.20 |
$25.20 |
$25.20 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$81.00 |
$81.00 |
$81.00 |
$72.80
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$58.78 |
$58.78 |
$58.78 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,031.50 |
$1,031.50 |
$1,031.50 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$725.36 |
$725.36 |
$725.36 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$426.26 |
$426.26 |
$426.26 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$147.00 |
$147.00 |
$147.00 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$276.00 |
$276.00 |
$276.00 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$159.00 |
$159.00 |
$159.00 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$42.00 |
$42.00 |
$42.00 |
$90.70
|
|
Vaccine rabies im
|
$1,890.56 |
$1,890.56 |
$1,890.56 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$211.80 |
$211.80 |
$211.80 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$163.80 |
$163.80 |
$163.80 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$327.60 |
$327.60 |
$327.60 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$195.60 |
$195.60 |
$195.60 |
$499.62
|
|
Vaccine tdap >=7 years im
|
$212.05 |
$212.05 |
$212.05 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$183.77 |
$183.77 |
$183.77 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$835.70 |
$835.70 |
$835.70 |
$365.17
|
|
Vad univ batt charger hm 1440
|
$31,713.90 |
$31,713.90 |
$31,713.90 |
$14,827.28
|
|
Vaginal bx
|
$12,224.43 |
$12,224.43 |
$12,224.43 |
$455.94
|
|
Vaginal hysterectomy
|
$20,007.05 |
$20,007.05 |
$20,007.05 |
$5,766.00
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$73.50 |
$73.50 |
$73.50 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$82.80 |
$82.80 |
$82.80 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$630.00 |
$630.00 |
$630.00 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$393.25 |
$393.25 |
$393.25 |
$90.33
|
|
Vancomycin hcl injection
|
$383.25 |
$383.25 |
$383.25 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$269.40 |
$269.40 |
$269.40 |
$136.13
|
|
Varicella zoster antibody igg
|
$109.80 |
$109.80 |
$109.80 |
$86.80
|
|
Varus/valgus strap padded/li
|
$225.58 |
$225.58 |
$225.58 |
$115.53
|
|
Vasopressin 20 unit/ml intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$51,105.11 |
$51,105.11 |
$51,105.11 |
$18,732.33
|
|
Veeg unmon 12-26 hrs
|
$5,417.40 |
$5,417.40 |
$5,417.40 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$1,054.80 |
$1,054.80 |
$1,054.80 |
$826.15
|
|
Vein x-ray liver w/hemodynam
|
$3,884.40 |
$3,884.40 |
$3,884.40 |
$3,483.84
|
